Insure California's undocumented immigrants: Raul Reyes

Last week a group of California lawmakers asked the Obama Administration to allow them to go forward with a plan to offer health insurance to undocumented immigrants. Under the terms of the Affordable Care Act, the undocumented are currently prohibited from accessing “Obamacare” coverage, with or without federal subsidies. Now California is seeking an “Innovation Waiver” from the government under a section of the ACA that allows states to experiment with approaches to getting residents covered. If approved, up to 30% of the state’s 2 million undocumented residents could potentially be eligible to buy into the state’s health insurance exchange.

California’s proposal is smart, compassionate, and makes good economic sense. It is a practical solution to a significant problem. If approved, it could potentially serve as a model for other states.

To be clear, California’s undocumented immigrants would not be buying health insurance with any kind of federal or state subsidy. This plan would not increase the deficit or cost state taxpayers anything. Undocumented immigrants would be paying the full costs of coverage under the state’s health exchange.

Should it win approval from the Department of Health and Human Services and the Department of Treasury, California’s proposal would be a win-win for state residents. The state health exchange would benefit from bringing in additional enrollees; California lawmakers estimate that 17,000 undocumented immigrants would participate in the first year if the administration grants the waiver request. Their participation would benefit the plan’s broader pool of enrollees by lowering costs, because immigrants tend to be younger and healthier than other Americans. Undocumented immigrants would gain from having access to comprehensive health coverage, instead of the higher-priced, limited plans many buy now.

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California’s decision to seek a waiver passed the state legislature with bipartisan support, and Governor Jerry Brown signed off on it as well. Consider that the state’s health exchange, known as “Covered California,” has been one of “Obamacare’s” success stories. But California is home to about a quarterof the nation’s 11 million undocumented immigrants. This group’s lack of coverage is a threat to the overall health of other residents. Healthier outcomes for all would be achieved by bringing more undocumented immigrants into the state exchange. It would also save money. Right now, if undocumented people get sick, they probably end up in an emergency room, and taxpayers foot the bill. One state lawmaker estimates that ER visits by the undocumented cost California $1.7 billion a year. If more undocumented people had preventative care and insurance of their own, these costs would likely drop.

What California hopes to do is shift some of the burden of paying for health coverage onto undocumented immigrants. As The Wall Street Journal has reported, our country’s undocumented population has become so large that some county governments have begun making public health services available to anyone, without asking about immigration status. The Journal surveyed 25 counties with the largest undocumented immigrant population; 20 were offering doctor visits, lab tests, shots and other services to all low-income residents. Among these locales were California’s Los Angeles County, Riverside County, Orange County and San Diego County. Wouldn’t it make better sense to at least get some of these folks to pay their own way?

Such logic has been lost on critics of California’s proposal. “This certainly has the potential to become a welfare magnet. You could easily imagine families with high medical expenses moving to California,” Michael F. Cannon, the director of health policy studies at the Cato Institute told The New York Times. Yet this is not a welfare proposal; again, undocumented immigrants would pay the full costs of coverage without any subsidies (and for the record, undocumented immigrants generally pay more in taxes than they ever get back in services). Nor is there any evidence that California’s plan would encourage unauthorized migrants to move there. Cannon’s complaint is pure conjecture.

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What we do know are the facts: Our country has no immediate plan to deal with our unauthorized population. They are not going anywhere, anytime soon.  Roughly two-thirds of them have lived here over a decade. Like everyone else, undocumented people get sick. Under the status quo, the sickest end up in public hospitals or the ER — who are required by law to treat them — and we foot the bill.

No one considers that a desirable, long-term outcome. No wonder the editorial board of The New York Timesendorsed California’s proposal.  They called it a “good idea that the Obama administration should support.” They’re right. Should it succeed, California’s plan could serve as an example for other states that want to increase enrollment in health exchanges while lowering taxpayer costs.

California is proposing a small step forward that could have positive implications for public health and immigration policy, and the Obama administration should grant their waiver request. The more people that have health insurance, the better off we all are.

Raul A. Reyes is an attorney, and an NBCNews.com and CNN Opinion contributor. Follow him on Twitter @RaulAReyes.

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